Lung-heart interaction as a substrate for the improvement in exercise capacity after body fluid volume depletion in moderate congestive heart failure

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Abstract

We investigated exercise capacity after fluid depletion in patients with moderate congestive heart failure (CHF). Twenty-one patients underwent ultrafiltration (mean volume ± SEM: 1,770 ± 135 ml). Echocardiography, tests of pulmonary function, and a cardiopulmonary exercise test with hemodynamic and esophageal pressure monitoring were performed before ultrafiltration and 3 months later. Tests without invasive measurements were repeated 4 and 30 days after ultrafiltration. Twenty-one control patients followed the same protocol but did not have ultrafiltration. Patients who underwent ultrafiltration and increased their oxygen consumption at peak exercise (peak VO2) by >10% at the 3-month evaluation (group A1, n = 9) were separated from those who did not (group A2, n = 8); 3 patients did not complete the follow-up. Four days after the procedure, peak VO2 had risen from 17.3 ± 0.8 to 19.3 ± 0.9 ml/min/ kg in group A1, and from 11.9 ± 0.7 to 14.1 ± 0.7 ml/min/kg in group A2 (p <0.01). Plasma norepinephrine and pulmonary function were consistent with a greater severity of the syndrome in group A2. At 3 months in group A1, the relations of filling pressure to cardiac index of the right and left ventricles were shifted upward; the esophageal pressure swing (differences between end-expiratory and end-inspiratory pressure) for a given tidal volume was lower; the peak exercise dynamic lung compliance had increased from 0.10 ± 0.05 to 0.14 ± 0.03 L/mm Hg (p <0.01). None of these changes were detected in group A2 and control patients. In moderate CHF, variations in lung mechanics and cardiac hemodynamics with body fluid volume withdrawal participate in the amelioration of the exercise performance; persistence of benefits is inversely related to the severity of CHF.

Original languageEnglish
Pages (from-to)793-798
Number of pages6
JournalThe American Journal of Cardiology
Volume76
Issue number11
DOIs
Publication statusPublished - Oct 15 1995

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Body Fluids
Ultrafiltration
Heart Failure
Exercise
varespladib methyl
Lung
Pressure
Heart Ventricles
Hemodynamics
Lung Compliance
Respiratory Function Tests
Tidal Volume
Mechanics
Exercise Test
Oxygen Consumption
Echocardiography
Norepinephrine
Control Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Lung-heart interaction as a substrate for the improvement in exercise capacity after body fluid volume depletion in moderate congestive heart failure",
abstract = "We investigated exercise capacity after fluid depletion in patients with moderate congestive heart failure (CHF). Twenty-one patients underwent ultrafiltration (mean volume ± SEM: 1,770 ± 135 ml). Echocardiography, tests of pulmonary function, and a cardiopulmonary exercise test with hemodynamic and esophageal pressure monitoring were performed before ultrafiltration and 3 months later. Tests without invasive measurements were repeated 4 and 30 days after ultrafiltration. Twenty-one control patients followed the same protocol but did not have ultrafiltration. Patients who underwent ultrafiltration and increased their oxygen consumption at peak exercise (peak VO2) by >10{\%} at the 3-month evaluation (group A1, n = 9) were separated from those who did not (group A2, n = 8); 3 patients did not complete the follow-up. Four days after the procedure, peak VO2 had risen from 17.3 ± 0.8 to 19.3 ± 0.9 ml/min/ kg in group A1, and from 11.9 ± 0.7 to 14.1 ± 0.7 ml/min/kg in group A2 (p <0.01). Plasma norepinephrine and pulmonary function were consistent with a greater severity of the syndrome in group A2. At 3 months in group A1, the relations of filling pressure to cardiac index of the right and left ventricles were shifted upward; the esophageal pressure swing (differences between end-expiratory and end-inspiratory pressure) for a given tidal volume was lower; the peak exercise dynamic lung compliance had increased from 0.10 ± 0.05 to 0.14 ± 0.03 L/mm Hg (p <0.01). None of these changes were detected in group A2 and control patients. In moderate CHF, variations in lung mechanics and cardiac hemodynamics with body fluid volume withdrawal participate in the amelioration of the exercise performance; persistence of benefits is inversely related to the severity of CHF.",
author = "Agostoni, {Pier Giuseppe} and Marenzi, {Gian Carlo} and Paolo Sganzerla and Emilio Assanelli and Marco Guazzi and Perego, {Giovanni Battista} and Gianfranco Lauri and Elisabetta Doria and Mauro Pepi and Guazzi, {Maurizio D.}",
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T1 - Lung-heart interaction as a substrate for the improvement in exercise capacity after body fluid volume depletion in moderate congestive heart failure

AU - Agostoni, Pier Giuseppe

AU - Marenzi, Gian Carlo

AU - Sganzerla, Paolo

AU - Assanelli, Emilio

AU - Guazzi, Marco

AU - Perego, Giovanni Battista

AU - Lauri, Gianfranco

AU - Doria, Elisabetta

AU - Pepi, Mauro

AU - Guazzi, Maurizio D.

PY - 1995/10/15

Y1 - 1995/10/15

N2 - We investigated exercise capacity after fluid depletion in patients with moderate congestive heart failure (CHF). Twenty-one patients underwent ultrafiltration (mean volume ± SEM: 1,770 ± 135 ml). Echocardiography, tests of pulmonary function, and a cardiopulmonary exercise test with hemodynamic and esophageal pressure monitoring were performed before ultrafiltration and 3 months later. Tests without invasive measurements were repeated 4 and 30 days after ultrafiltration. Twenty-one control patients followed the same protocol but did not have ultrafiltration. Patients who underwent ultrafiltration and increased their oxygen consumption at peak exercise (peak VO2) by >10% at the 3-month evaluation (group A1, n = 9) were separated from those who did not (group A2, n = 8); 3 patients did not complete the follow-up. Four days after the procedure, peak VO2 had risen from 17.3 ± 0.8 to 19.3 ± 0.9 ml/min/ kg in group A1, and from 11.9 ± 0.7 to 14.1 ± 0.7 ml/min/kg in group A2 (p <0.01). Plasma norepinephrine and pulmonary function were consistent with a greater severity of the syndrome in group A2. At 3 months in group A1, the relations of filling pressure to cardiac index of the right and left ventricles were shifted upward; the esophageal pressure swing (differences between end-expiratory and end-inspiratory pressure) for a given tidal volume was lower; the peak exercise dynamic lung compliance had increased from 0.10 ± 0.05 to 0.14 ± 0.03 L/mm Hg (p <0.01). None of these changes were detected in group A2 and control patients. In moderate CHF, variations in lung mechanics and cardiac hemodynamics with body fluid volume withdrawal participate in the amelioration of the exercise performance; persistence of benefits is inversely related to the severity of CHF.

AB - We investigated exercise capacity after fluid depletion in patients with moderate congestive heart failure (CHF). Twenty-one patients underwent ultrafiltration (mean volume ± SEM: 1,770 ± 135 ml). Echocardiography, tests of pulmonary function, and a cardiopulmonary exercise test with hemodynamic and esophageal pressure monitoring were performed before ultrafiltration and 3 months later. Tests without invasive measurements were repeated 4 and 30 days after ultrafiltration. Twenty-one control patients followed the same protocol but did not have ultrafiltration. Patients who underwent ultrafiltration and increased their oxygen consumption at peak exercise (peak VO2) by >10% at the 3-month evaluation (group A1, n = 9) were separated from those who did not (group A2, n = 8); 3 patients did not complete the follow-up. Four days after the procedure, peak VO2 had risen from 17.3 ± 0.8 to 19.3 ± 0.9 ml/min/ kg in group A1, and from 11.9 ± 0.7 to 14.1 ± 0.7 ml/min/kg in group A2 (p <0.01). Plasma norepinephrine and pulmonary function were consistent with a greater severity of the syndrome in group A2. At 3 months in group A1, the relations of filling pressure to cardiac index of the right and left ventricles were shifted upward; the esophageal pressure swing (differences between end-expiratory and end-inspiratory pressure) for a given tidal volume was lower; the peak exercise dynamic lung compliance had increased from 0.10 ± 0.05 to 0.14 ± 0.03 L/mm Hg (p <0.01). None of these changes were detected in group A2 and control patients. In moderate CHF, variations in lung mechanics and cardiac hemodynamics with body fluid volume withdrawal participate in the amelioration of the exercise performance; persistence of benefits is inversely related to the severity of CHF.

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